Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predicts Silent Coronary Artery Disease and Renal Outcome in type 2 Diabetic and Prediabetic subjects.

Sanchez, Ramiro A; Sanchez, Maria Josefina; Ramirez, Agustin J

INTRODUCTION Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. AIMS To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD. METHODS We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with an A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, a coronary angiography was performed. In addition, a PWV, glomerular filtration rate, and ACR were evaluated. STATISTICS mean±SEM, and ANOVA among groups. RESULTS 48.59% of DM2 and 25.58% of GI patients had silent coronary artery disease. DM2 and GI patients with CAD had higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2. CONCLUSIONS Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors showed in DM2. Diabetic and prediabetics, still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.